Expert Advice

Michelle Deal-ZimmermanThe Baltimore Sun

Leg pain is often dismissed as a sign of aging, but it could also be a sign of decreased blood flow to the limb, a condition known as peripheral arterial disease. The American Heart Association says more than 8 million people are affected by peripheral arterial disease (PAD), but nearly 75 percent may not know it because they do not experience any symptoms. But the disease can be indicative of more serious blockages elsewhere in the body. "If you look at 100 people who have peripheral arterial disease, within five years nearly a third will die because of heart attacks and strokes," says Dr. Mark Gonze, chief of vascular surgery at St. Joseph Medical Center.

What is peripheral arterial disease (PAD)?

Peripheral artery disease is a general terminology for hardening of the arteries. ... This is a disease where our arteries that are responsible for sending all of the blood throughout our body from our toes ... to our brains start to narrow from plaque [fatty buildup] and slow the blood flow.

How is it related to heart disease?

Heart disease is very similar as far as hardening of the arteries. "Peripheral" is implying that the narrowing is in the circulation that goes throughout the body as opposed to being in the heart. Same disease but in a different location.

What are the risk factors for PAD and who is at risk?

The No. 1 risk factor is smoking; No. 2 is diabetes. Those two together are responsible for 80 to 85 percent of all hardening of the arteries that develop. Also, uncontrolled high blood pressure, high cholesterol or family history are risk factors. As we age, that ends up becoming a risk factor also. To some extent, foods that we eat can increase our risk -- high-fat foods, fried foods -- but these are lower contributing factors as opposed to the others.

What are symptoms that should cause concern?

Symptoms vary depending on which artery becomes blocked. We worry about things like strokes or ministrokes when the carotid artery becomes blocked. We worry about leg pain ... because as [patients] start to walk and the muscles start to work, they can't get enough blood, so they start aching. In some situations, we worry about uncontrolled high blood pressure because of blockages developing in the kidney arteries. ... Unfortunately, two-thirds of most patients have no symptoms.

How is PAD diagnosed?

Diagnosis is primarily through an evaluation by the primary care physician, who can assess how likely the patient is to have a problem by feeling the pulses in the neck arteries or in the legs. The main way is through an ultrasound test that is noninvasive where we can look at the arteries and see how the [blood] flow is going.

What is the treatment?

First treatment is to try to slow the disease down. There is no cure once you have hardening of the arteries. [The disease] can be very fast or can be very slow. The risk factors need to be aggressively treated. First, you have to stop smoking. I tell my patients don't even look at a cigarette ad. Keeping the blood pressure under control and getting the cholesterol down will really help slow the disease down.

What about drug therapy?

For leg pain, there is Cilostazol that helps patients walk better. Aspirin and Plavix are all good medicines to reduce heart attacks and strokes, and anyone who has any element of PAD needs to be on one of those medications.

If surgery is required, what is the procedure?

We try minimally invasive first with balloons and stents, and sometimes a bypass operation or removing the hardened arteries. Occasionally we do need to do surgery.

Are there any new advances in treatment or diagnostic tools on the horizon? For example, I have read about the Silverhawk device.

From an interventional point of view, we are able to freeze the plaque with liquid nitrogen ... and remove it. New stents are being developed, similar to medicated stents for the heart. The Silverhawk has a small device inside a catheter that helps remove plaque by shaving off the inside lining of the blocked artery ... that allows the blood to flow a little better. Hopefully, [in the future] we will start to have medications that will slowly dissolve these plaques.

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